When does one perform surgery for Adult Kyphoscoliosis?
When kyphoscoliosis begins to be painful, conservative treatment may improve the pain and stabilize the condition however it will never correct the actual deformity. When symptoms are not controlled by conservative management more aggressive treatment may be necessary. Surgery for kyphoscoliosis consists of correcting some of the spinal deformity and creating a fusion which means fixing the vertebrae of the spine together by applying instrumentation (metal implants: rods, screws, wires, hooks…) and bone graft. The goal of surgery is to provide the patient with a fused spine which will no longer deform and remain in a position of balanced posture (head centered above pelvis). There are various technique employed to achieve this result and an experienced surgical team is essential.
Can exercises correct a Scoliosis?
One must be aware that scoliosis curves can neither be improved nor their progression prevented by exercises. However exercises for spine stabilization are beneficial for most people with spine problems. After careful evaluation by a spine specialist most patients with scoliosis are encouraged to participate in athletics without reservation (swimming and bicycling are probably better than running).
It is mostly recommended to engage in aerobic exercises with limited amount of resistance (no more than 40 lbs.). Gym exercises can be pursued with upper extremity work outs in sitting and supine positions, using free weights or machines (nautilus or cybex) to indirectly strengthen the supportive musculature of the back. Lower extremities exercises should avoid excessive work in deep knee or hip flexion. Keeping in shape, maintaining normal weight, eating a balanced diet and avoiding smoking are all part of a healthy back regimen.
When is a Brace used to treat Idiopathic Scoliosis ?
Idiopathic scoliosis is the most common form of scoliosis. This deformity of the spine has no clearly known cause and tends to affect girls more than boys. School screening and regular evaluations by a pediatrician can be helpful in detecting scoliosis at an early age. There are only a few effective treatments which can be recommended. The treatment of a specific curvature will depend upon the severity of the curvature and the age (or skeletal maturity) of a person. In girls, the onset of menarche is a useful guide to the risk of curve progression since it correlates with the decline in growth.
Before puberty a scoliotic deformity may be amenable to treatment with a corrective brace. Bracing may slow the progression of deformity although it will most likely not alter the deformity permanently. Thus a brace in some cases can so to say “hold” the scoliosis so that it does not become severe by the end of growth. After growth has stopped in an adolescent, the likelihood of curve worsening is markedly reduced. As a guideline a curve measuring from 30 to 45 degrees in a growing adolescent may be treated by bracing and close follow-up by a spine specialist. After puberty a curve of 45 degrees or more must be treated by a specialist who may want to watch it for a period of time if the spine is still well balanced, however surgery in the more severe cases is the most common treatment. Bracing modalities and surgery techniques may vary from case to case and should be recommended by an experienced spine specialist after a complete evaluation.